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Sunday, November 14, 2010

Deep inside a 34-page proposed federal regulation are a few sentences that are causing nightmares for mental health advocacy groups.

The regulation, from the Social Security Administration, could change how people with mental illnesses are evaluated for disability payments.

The angst is over whether standardized testing will be required to determine such payments. The proposed regulation is not clear on that controversial subject. At one point it says standardized tests will not be required but then goes into detail on how the exams would be used to determine a person's fitness for work.

The confusion over the wording — and fears that it will be interpreted to require testing — has advocates by the hundreds calling in comments to the Social Security Administration, which will accept them until Wednesday.

"This is something that's never been required before," said Scott Burgess of the Alexian Brothers Center for Mental Health, an outpatient clinic in Arlington Heights, who is concerned the proposed rule could lead to testing despite wording that might suggest otherwise.

"They have not been able to demonstrate to anybody that (testing) is a reliable tool to tell who is capable of working and who is not."

The confusion has prompted advocates to urge officials to back away from the provision before the measure is put in final form.

"We don't have good tests for this, and the way they are describing how the tests would be used suggests the goal and likely effect is to dramatically reduce the number of people who are eligible for disability," said Mark Heyrman of the Mental Health Summit, a Chicago-based advocacy group.

Social Security's disability programs pay a small stipend — ranging from roughly $500 to $1,000 a month — to those it determines to be incapable of gainful employment. Many of the 16 million people who receive disability have physical infirmities, such as bad backs or heart conditions, but some have mental disorders.

State adjudicators decide whether a person's condition is severe enough to warrant a government check, and they're tough judges: In Illinois, only a third of those who seek disability are approved the first time they apply.

For people with mental illnesses, the state makes its decisions based primarily on medical records and the recommendations of psychologists and psychiatrists, officials said. But the new regulation's lengthy discussion of testing has led some to believe that Social Security intends to emphasize it.

Dr. Mark Amdur, a psychiatrist who works with Chicago's Thresholds mental health clinic, said no test can reliably gauge whether someone with a mental illness is capable of working. If that becomes a condition for applying for disability, he said, he expects even fewer people to receive it.

That would have disastrous results, he said. In Illinois, adults typically must be declared disabled before they can receive Medicaid, the government's health insurance for the poor. So no disability would also mean no health care, he said.

"It's a lifeline," he said. "Without it, these people are just homeless on the streets. My argument is we're paying for (people with mental illness) one way or the other, through arrests and housing people in jail, and in worsening health because people aren't being treated."

Social Security officials declined to speak about the proposal, citing a policy of remaining silent while the public has its say. But some who work in the system say the advocates' fears are overblown.

Tom Yates, an attorney with Chicago's Health and Disability Advocates, has a benign interpretation of the proposed rules. He thinks Social Security wants only to clarify its expectations for the few times a standardized test might be used in a mental illness disability claim.

"I've been doing cases for 26 years now, and I just don't think the changes will make that much of a difference," he said.

Burgess, though, said even apparently straightforward rules are open to interpretation. Social Security regulations say someone can claim disability after that person is deemed incapable of working. But in Illinois, Burgess said, adjudicators usually won't declare someone disabled unless he or she has been out of work for a year. State officials denied that was the case.

"Where there is any level of gray area, it becomes much more subject to individual interpretation," he said.

After public comment ends, the agency could spend months crafting the final rule, advocates say.

About Me

I am full-time Mass Communication faculty at Towson University in Maryland and adjunct faculty in the City University of New York (CUNY) Master's in Disability Studies program.
I research media and disability issues and wrote a 2010 book on the subject: Representing Disability in an Ableist World: Essays on Mass Media, published by Advocado Press.
The media have real power to define what the public knows about disability and that's what I research.